YATES COUNTY SPORTSMEN’S ASSOCIATION, INC.
MEMBERSHIP APPLICATION
APPLICANT INFORMATION
Name:
Email:
Phone:
Address:
Cell Phone:
City:
State:
TYPE of MEMBERSHIP (circle one):
Regular ($40)
ZIP Code:
Family ($40)
Seasonal ($20)
Military (No Fee)
BACKGROUND INFORMATION
Are you a member of the following:
National Rifle Association?
YES
NO
Do you have a NYS Handgun Permit?
YES
NO
Have you ever been convicted of a felony?
YES
NO
Other Sporting or Gun Club?
YES
NO
Is, or has, your hunting license been revoked?
YES
NO
Have you ever been expelled from a gun/ sporting club?
YES
NO
REASONS FOR WANTING TO JOIN THE YATES COUNTY SPORTSMEN’S ASSOCIATION
Use of Range only __________ Active support in club events_________________
I will help with the following (circle one or more):
Club Projects
Range Safety
Archery
Trap
Favorite Shooting Sports:
Handgun
Shooting Events
Fundraising
Social Events
Club Sponsor:
List any skills you have that would benefit the club:
Carpentry
Plumbing
Electrical
Surveying
Range Officer
Trainer
Other:
FAMILY INFORMATION IF FAMILY MEMBERSHIP
Spouse’s Name:
Child’s Name
Child’s Name
Child’s Name
Child’s Name
REFERENCES - IF NO CLUB SPONSOR
Name
Address
Phone
SIGNATURES
I understand that falsification of any information on this application is cause for disapproval. I further understand that once accepted as a member, I
may be dismissed for any conduct in violation of the Association Bylaws as interpreted by the Executive Committee of the YCSA. I understand the
requirements of membership for hunting privileged and agree to abide by these rules and all other rules of the Association. I authorize the verification
of the information provided on this form.
I read and agree to abide by the YCSA Bylaws and Range Rules.
Signature of Applicant:
Date:
Signature of Sponsor:
Date:
Return completed application with Dues and an ID photo to:
Yates County Sportsmen’s Association
P O Box 296, Penn Yan, NY 14527
Executive Committee Approved:
YES
NO
Date
YES
NO
Date
Executive Committee Signature:
Membership Approval:
Approved October 2013